Table 2.
Characteristics of included studies.
| First Author [Ref] | Aim | Participant Characteristics | Wearable Device | Sensors Type (Short) | Experimental Intervention | Control Intervention | Timing | Balance and Gait Outcome Measure | Evaluation Time Points |
|---|---|---|---|---|---|---|---|---|---|
| Azerpaikan et al. [40] | To study the effect of a neurofeedback training on balance problems associated with Parkinson’s disease. | TOT n = 16 patients with PD EG: n = 8 Mean age: 74.23 ± 3.51 years Female: n = 4 CG: n = 8 Mean age: 75.16 ± 3.64 years Female: n = 4 |
Biograph Infiniti Software system (version 5.0), the ProComp differential amplifier (Thought Technology Ltd, Montreal, Quebec) for NeuroFeedback training sessions (FlexComp Infiniti encoder, TT-USB interface unit, fiber optic cable, USB cable) | EEG SENSORS | EG: Neurofeedback training with EEG generator | EG: Sham Neuro Feedback Training using sham EEG generator | D:8 sessions T: 30 min F: 3 days/week |
BBS*, Limit of stability * | PRE, POST |
| Byl et al. [41] | To evaluate the effectiveness of supervised gait training with and without visual kinematic feedback | TOT: n = 24 stroke and PD EG: n = 12 Stroke: n = 5 Mean age: 66.2 ± 5.0 years Female: n = 3 PD: n = 7 Mean age: 68.5 ± 3.6 years Female: n = 4 CG: n = 12 Stroke: n = 7 Mean age: 60.8 ± 5.4 years Female: n = 5PD: n = 5 Mean age: 70.0 ± 2.9 years Female: n = 2 |
Wireless joint angle sensors and Smart Shoes | IMU, PRESSURE SENSORS | EG: visual kinematic feedback on the computer screen during progressive and task-oriented balance and gait training activities | CG: balance and gait training activities | D: 12 sessions (6–8 weeks) T: 90 min (30 min visual kinematic feedback in the EG) F: NA |
Gait Speed; Step Length; TBS, 6MWT, DGI, 5TSS, TUG, BBS, FOG-Q | PRE, POST |
| Carpinella et al. [42] | To test the feasibility of a wearable biofeedback system in a typical rehabilitation gym and analyze the effect on balance and gait outcome measures compared to physiotherapy without feedback. | TOT: n = 42 subjects with PD EG: n = 17 Mean Age: 73 ± 7.1 years Female: n = 3 CG: n = 20 Mean Age: 75.6 ± 8.2 years Female: n = 11 |
Gamepad System (IMU, PC and Customized software) | IMU SENSORS | EG: balance and gait functional tailored exercises using Gamepad System | CG: personalized balance and gait exercises defined by the clinical staff | D: 20sessions T:45 min F:3 times/week |
BBS *, Gait Speed, UPDRSIII, TUG, ABC, FOGQ, COP ML sway *, COP AP sway, Tele-healthcare Satisfaction Questionnaire-Wearable Technologies | PRE, POST, FU |
| Cha et al. [46] | To compare the effectiveness of auditory feedback stimulation from the heel and forefoot areas in terms of ambulatory functional improvements in stroke patients | TOT n = 31 stroke subjects EG1: n = 11 Mean age: 64.6 ± 10.6 Female: n = 3 EG2: n = 10 Mean age: 63.0 ± 4.7 Female: n = 3 CG: n = 10 Mean age: 61.8 ± 9.8 Female: n = 4 | A PedAlert Monitor 120 (PattersonMedical Holdings Inc., Warrenville, IL, USA) |
PRESSURE SENSORS | EG1: gait training with active weight bearing on the paretic heel with auditory feedback EG2: gait training with auditory feedback from paretic metatarsals | CG= gait intervention | D: 6 weeks T: 50 min (30 min of conventional therapy + 20 min of gait intervention with or without auditory feedback) F: 3 × week | Gait speed, FGA *, TUG, COP length EO *, COP length EC, COP velocity EO *, COP velocity EC | PRE, POST |
| Cho et al. [47] | To examine whether visual biofeedback tracking training can improve gait performance in chronic stroke patients. | TOT n = 10 Stroke subjects EG: n = 5 Mean age: 46.2 ± 7.3 years Female: n = 2 CG: n = 5 Mean age: 48.8 ± 6.3 years Female: n = 1 |
A double-axis electrogoniometer (Biometrics Ltd. Ladysmith, VA) was used to record the instant degrees of knee joint flexion–extension. Series of PC generated sine waves at 0.2 Hz were displayed on a PC monitor at 80 cm distance from the eyes of the subject |
ELECTRO-GONIOMETER | EG: visual biofeedback tracking training | CG: not Reported | D:20 sessions (4 week) T: 39 min F: 5 days/week | Motoricity Index, Modified Motor Assessment Scale, Gait Speed. | PRE, POST |
| Choi et al. [48] | To compare gait intervention with auditory feedback induced by active weight bearing on the paralyzed side with the effects of the general gait training method | TOT n = 24 stroke subjects EG: n = 12 Mean age: 62.8 ± 4.8 Female: n = 4 CG: n = 12 Mean age: 59.7 ± 10.2 Female: n = 4 | PedAlert Monitor 120, (Patterson Medical Holdings, Inc.). | PRESSURE SENSORS | EG: gait intervention with auditory feedback | CG: general gait training over the ground. | D: 6 weeks T: 50 min (30 min of conventional therapy + 20 mins of gait training with or without bfb) F: 3 × week | Gait Speed (10MWT) *, FGA *, TUG *, COP length EO *, COP length EC* | PRE, POST |
| Cozean et al. [49] | To study the effect of EMG Biofeedback and FES as therapies for gait dysfunction in patients with hemiplegia after stroke. | TOT n = 36 Patients with stroke EG1: n = 9 Mean age:51 ± (not specified) Female: n = 4 EG2: n = 10 Mean age: 52 ± (not specified) Female: n = 2 G3: n = 8 Mean age: 56 ± (not specified) Female: n = 6 CG: n = 9 Mean age: 62 ± (not specified) Female: n = 2 |
Not reported | EMG SENSORS | EG1: EMG biofeedback during static and dynamic activities EG2: FES during static and dynamic activities EG3: EMG biofeedback+FES during static and dynamic activities | CG: conventional Physical Therapy | D: 6 week T: 30 min F: 3 × Week | ankle angle (swing phase) *, knee angle (swing phase) *, stride length, gait speed* | PRE, POST |
| El-Tamawy et al. [43] | To examine the influence of paired proprioceptive cues on gait parameters of individuals with PD. | TOT n = 30 subjects with PD EG: n = 15 Mean age: 61.4 ± 7.28 Female: not specified CG: n = 15 Mean age: 63.2 ± 5.6 Female: not specified | The vibratory device, OPTEC Co. LLtd. | PRESSURE SENSORS | EG: individually designed physiotherapy and traditional gait training plus treadmill training with vibratory stimuli | CG: individually designed physiotherapy and traditional gait training including instructions to walk with long steps. | EG: D: 8 weeks T: 51–70 min F: 3 sess/week, CG: D: 8 weeks T: 45 min F: 3 sess/week | Cadence *, Stride length *, Gait speed *, Walking distance * | PRE, POST |
| Ginis et al. [44] | To test the feasibility of CuPID system in the home environment and verify differential effects of CuPID training versus conventional home-based gait intervention | TOT n = 40 subjects with PD EG: n = 22 Mean age: not specified Female: not specified CG: n = 18 Mean age: not specified Female: not specified |
The CuPiD system consisted of a smartphone (Galaxy S3-mini, Samsung, South Korea), a docking station and two IMUs (EXLs3, EXEL srl., Italy) |
IMU SENSORS | EG: received weekly home visit and patients were instructed to walk with the CUPID system | CG: received weekly home visit by the researcher who gave advice on gait and freezing, and patients were instructed to walk without using the CUPID system | D: 6 weeks T: 30 min F:3 times/week | MiniBEST *, FSST, FES-I, 2MWT, UPDRS III, NFOG-Q, Comfortable gait and Dual task activities (gait speed, stride length, DS time); | PRE, POST, FU |
| Intiso et al. [50] | to evaluate the efficacy of electromyographic biofeedback compared with physical therapy. | TOT n = 16 Patients with stroke EG: n = 8 Mean age: 61.3 ± 12.3 years Female: n = 4CG: n = 8 Mean age: 53.5 ± 18.5 years Female: n = 3 |
table Satem PT 1015 and a walking Satem EMG Combitrainer PT 9115. |
EMG SENSORS | EG: EMG Biofeedback and Physical Therapy (standard exercise bobath, facilitation, and inhibition techniques, neurofacilitatory techniques) | CG: Physical therapy (standard exercise bobath, facilitation and inhibition techniques, neurofacilitatory techniques) | D: 2 months T: 60 min F: daily physical therapy (Only EG 30 session of EMG BFB) | Basmajian scale *, Gait speed, step length, ankle angle (swing phase) *, ankle angle (heel contact) | PRE, POST |
| Jonsdottir et al. [51] | to assess the efficacy of EMG-BFB applied in a task-oriented approach based on principles of motor learning to increase peak ankle power of the affected leg and gait velocity in patients with chronic mild to moderate hemiparesis | TOT n = 20 Patients with stroke EG: n = 10 Mean age: 61.6 ± 13.1 years Female: not specified CG: n = 10 Mean age: 62.6 ± 9.5 years Female: not specified |
BFB device: (SATEM Mygotron, SATEM srl, Rome, Italy); EMG, system (band-pass filtered at 20 to 950 Hz and then amplified with a gain of 40 000 (50 mVrms range), | EMG SENSORS | EG=Task-oriented gait training with EMG BFB device | CG= conventional physical therapy (at least 15 mins of gait training in each session) | D: 20 session T: 45 min F: 3 × Week | Gait speed *, ankle power peak at push-off *, stride length *, knee flexion peak | PRE, POST, FU |
| Jung et al. [52] | to examine the effect of gait training using a cane with an augmented pressure sensor to improve weight bearing on the nonparetic leg in patients with stroke | TOT 22 stroke subjects EG: n = 12 Mean age: 56.4 ± 11.1 Female: n = 4 CG: n = 10 Mean age: 56.3 ± 17.1 Female: n = 3 | An instrumented cane, outfitted with a pressure sensor (CD 210-K200, Dacell Co. Ltd., Korea) connected to an indicator (DN30W, Dacell Co. Ltd., Korea) | PRESSURE SENSORS | EG: gait training with auditory feedback | CG: gait training without auditory feedback | D: 4 weeks T: 60 min (30 min +30 min gait training with or without bfb) F: 5 × week | Peak force cane *, Gait speed *, single support time * | PRE, POST |
| Ki et al. [53] | to examine the effects of auditory feedback during gait on the weight bearing of patients with hemiplegia resulting from a stroke. | TOT n = 30 stroke subjects EG: n = 12 Mean age: 55.3 ± 9.2 Female: n = 4 CG: n = 13 Mean age: 60.1 ± 12.3 Female: n = 2 | A pressure gauge Ped-AlertTM120 (ORBITEC, USA) | PRESSURE SENSORS | EG: neurodevelopmental treatment with auditory feedback | CG: neurodevelopmental treatment | D: 4 weeks T: NA F: NA. | TUG *, Stance phase duration, Single support time. | PRE, POST |
| Lee et al [54] | to examine the effect of neurofeedack training on brain waves control and gait performed under dual-task conditions. | TOT n = 20 stroke subjects EG: n = 10 Mean age: 53.2 ± 6.46 Female: n = 4 CG: n = 10 Mean age: 54.7 ± 3.77 Female: n = 3 | The Procomp Infiniti system (SA7951 version 5.1, Thought Technology, Canada) was used for neurofeedback training. The QEEG-8 (LXE3208, LAXHA Inc., Korea) system was used to measure brain waves | EEG SENSORS | EG: neurofeedback training | CG: pseudo-neurofeedback training (sham neurofeedback) | D: 8 weeks T: 30 min F: 3 × week | gait speed *, cadence *, stance phase percentage, and plantar foot pressure (dual task) * | PRE, POST |
| Lupo et al. [55] | To evaluate the efficacy of training involving the use of a combined biofeedback system versus conventional balance training | TOT n = 15 stroke subjects EG: n = 9 Mean Age: 52.56 ± 13.92 Female: n = 3 CG: n = 6 Mean Age: 65.66 ± 9.64 Female: n = 1 | The RIABLO™ (CoRehab, Trento, Italy) system comprised of several inertial measurement unitsand a force platform connected wirelessly to a computer | IMU SENSORS AND FORCE PLATFORM | EG: balance training with RIABLO biofeedback system using a video interface. | CG: conventional balance training without the use of the RIABLO biofeedback system | D: 10 sessions T: 20 min F:3 times/week | BBS *, RMI, COP length EO *, COP length EC * | PRE, POST, FU |
| Mandel et al. [56] | to investigate the efficacy of electromyographic (EMG) versus a novel biofeedback (BFB) approach to improve ankle control and functional gait in stroke patients | TOT n = 37 stroke subjects EG1: n = 13 Mean age: 54.7 ± 13.9 years Female: n = 5 EG2: n = 13 Mean age: 57.5 ± 14.2 years Female: n = 5 CG: n = 11 Mean age: 56.8 ± 12.8 years Female: n = 1 |
Two channels of EM-BFB, a Lamoureux-type parallelogram electrogoniometer was and a computerized system to provide audiovisual feedback of ankle position during dorsiflexion and plantar flexion. |
EMG SENSORS and ELECTRO-GONIOMETER | EG1: EMG biofeedback training (computer-generated auditory and visual feedback of calf and pretibial muscle activity during active ankle movements) EG2: EMG biofeedback followed by rhythmic positional biofeedback (computer-generated single-channel feedback of dorsiflexion and plantar flexion) | CG: No training | D: 24 session (EG2 performed 12 session of EMG biofeedback and 12 session of Rythmical positional biofeedback) T: not specified F: 3 × Week | Gait speed *, ROM * | PRE, POST, FU |
| Schwenk et al. [58] | To evaluate the feasibility and experience in using the new sensor-based training in a sample of patients with clinically confirmed amnestic MCI | TOT n = 32 subjects with MCI EG: mean age 77.8 ± 6.9 Female: n = 7 CG: mean age 79 ± 10.4 Female: n = 5 | The technology consisted of a 24 inch computer screen, an interactive virtual user interface, and 5 inertial sensors (LegSysTM, BioSensics LLC, MA, USA) | IMU SENSORS AND FORCE PLATFORM | EG: postural balance exercises during standing (ankle point-to-point reaching tasks and virtual obstacles crossing tasks) using biofeedback training | CG: No training | EG: D: 4 weeks T: 45 mins F: 2 sessions/week | CoM area EO *, CoM area EC, CoM sway ML EO *, CoM swayML EC, CoM sway AP EO *, CoM sway AP EC, Gait Speed, Gait stride time variability, FES-I * | PRE, POST |
| Sungkarat et al. [57] | To determine whether improved symmetrical weight bearing somatosensory feedback would result in improved gait and balance in people with stroke | TOT n = 35 people with stroke EG: n = 17 Mean Age: 52.12 ± 7.17 years Female: n = 5 CG: n = 18 Mean Age: 53.83 ± 11.18 years Female: n = 6 | Insole Shoe Wedge and Sensors (I-ShoWS) | PRESSURE SENSORS | EG: conventional rehabilitation and gait training with I-ShoWS set-up | CG: conventional rehabilitation and gait training without I-ShoWS set-up | D:15 sessions T: 60 min/session, (30 min gait training and 30 min conventional) F: 5 days/week | Gait speed *, Step Length asymmetry ratio*, Single Support time asymmetry ratio *, Load on paretic leg during stance (% Body Weight) *, BBS *, TUG * |
PRE, POST |
| van den Heuvel et al. [45] | to investigate the feasibility of visual feedback-based balance training (VFT) and to compare the effects of the training program with conventional training | TOT n = 33 subjects with PD EG: mean age 63.9 ± 6.39 Female: n = 5 CG:mean age 68.8 ± 9.68 Female: n = 8 | Flat-panel LCD monitor connected to a PC (Motek Medical, Amsterdam, The Netherlands), Force plate (Forcelink, Culemborg, and The Netherlands) and Inertial sensors (X sens, Enschede, The Netherlands) | IMU SENSORS | EG: interactive balance games with explicit augmented visual feedback | CG: conventional balance training recommended by the guidelines for physical therapy. | D: 5 weeks T: 60 min (45 min balance workstation) F: 2 sess/week | BBS; Single leg stance test; Gait speed, FES-I, UPDRSIII* | PRE, POST, FU |
* = p ≤ 0.005; 5TSS = 5 Time sit to stand; 2MWT = 2 min Walk Test; 6MWT = 6 min Walk Test; AP = Antero-posterior; BFB = Biofeedback; BBS = Berg balance scale; CG = Control group; COM = Centre of movement; COP = Centre of pressure; D = Duration; DGI = Dynamic Gait Index; EEG = Electroencephalogram; EG = Experimental group; EMG = Electromyography, F = Frequency; FES-I = Fall efficacy scale; FGA = Functional gait assessment; FOG-Q = Freezing of gait questionnaire; FSST = Four Square step test; IMU = Inertial movement unit; MCI = Mild cognitive impairment; ML = Medio-lateral; NFOG-Q = New freezing of gait questionnaire; PD = Parkinson disease; RMI = Rivermead mobility index; ROM = Range of motion; T = time; TBS = Tinetti balance scale; TOT = Total; TUG= Timed up and go; UPDRS = Unified Parkinson disease rating scale.